A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study.

BACKGROUND: Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. OBJECTIVE: This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. METHODS: Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. RESULTS: Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03), assessment of a patient's digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed "somewhat comfortable" on any of the above measures. CONCLUSIONS: Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum.

Balancing the Roles of Clinicians and Police in Separating Firearms from People in a Dangerous Mental Health Crisis: Legal Rules, Policy Tools, and Ethical Considerations.

In COVID's immediate wake, the 2020 death toll from a different enemy of the public's health - gun violence - ticked up by 15 percent in the United States from the previous year. Meanwhile, the U.S. Supreme Court issued an opinion in Caniglia v. Strom that will allow people who have recently threatened suicide - with a gun - to keep unsecured guns in their home unless police take time to obtain a search warrant to remove them.

Socially Distanced Emergencies: Clinicians' Experience with Tele-behavioral Health Safety Planning.

Psychiatry has experienced a rapid expansion in providing behavioral health services using virtual means; however, little is known regarding clinicians' experience in managing patient emergencies during virtual encounters. We present survey data from a large academic psychiatry department designed to better understand safety planning while delivering ambulatory tele-behavioral health services during the COVID-19 pandemic. Clinical faculty in the department were sent an anonymous electronic survey developed and distributed using the Qualtrics™ software. Departmental leadership provided a list of clinicians who performed ambulatory care. SAS 9.4 was used to conduct statistical analysis for associations between variables. Approximately one quarter (23.3%) of respondents engaged in proactive safety planning for most of their outpatient virtual visits, while a little over half (53.2%) of clinicians implemented emergent safety planning between just one to five visits. Clinicians who more frequently implemented emergency protocols were more likely to engage in proactive safety planning prior to emergencies (p = 0.0115). 10.8% of participants petitioned for civil commitment, though those that did identified numerous challenges. Our results reinforce the importance in appropriate training regarding best practices while providing tele-behavioral health care, with increased awareness for conducting safety planning and implementing emergent protocols. Furthermore, while petitioning for civil commitment is a relatively low base rate event in a large outpatient practice, these data and narrative feedback help to outline challenges and potential measures to improve this process for all parties. Increased attention to protocols and procedures are key as the utilization of virtual care within psychiatry continues.

Videoconferencing of Involuntary Commitment Hearings in the COVID Era.

Involuntary commitment hearings have been conducted utilizing videoconferencing technology for several years. There is limited information available in the published psychiatric literature pertaining to the use of this technology for commitment proceedings. The University of North Carolina Hospitals adopted a remote videoconferencing (tele-hearing) format for its civil commitment proceedings in response to the COVID-19 pandemic, and this provided us with the opportunity to investigate the use of such an arrangement. In this article, we review the use of videoconferencing for commitment hearings. We also review select case law related to the utilization of this technology for commitment hearings, which reveals that the courts have not been in full agreement about the legality of a virtual commitment tele-hearing format. Given that the general use of virtual platforms has expanded during the COVID-19 pandemic and many individuals and organizations are gaining confidence in operating this technology, more institutions may decide to shift to a virtual commitment scheme or make a commitment tele-hearing format permanent after the pandemic.

Navigating Care From Afar: Ethical Considerations for Police Welfare Checks.

The clinical practice of contacting law enforcement to perform safety welfare checks for persons who have missed psychiatry appointments is commonly regarded as benign. However, in nonemergency situations, these interventions may carry greater risk than is usually assumed, especially if the person whose welfare is being checked belongs to a racial-ethnic minority group, and there is little evidence on the safety and effectiveness of these interventions. This Open Forum presents a case analysis to examine the central ethical considerations for these situations. Using crisis intervention teams, making repeated phone calls, or using other methods of communication may be clinically and ethically preferable to contacting law enforcement.

Building for the future: the creation of a residency training track to foster innovation through clinical informatics in psychiatry.

Early clinical informatics (CI) education provides an introduction to CI methodologies for resident physicians to apply within their boarded specialties. A specialty notably absent from the effort to train residents in CI is psychiatry. We present a novel means of integrating CI exposure into a structured educational track within a psychiatry residency training program. The clinical informatics track at the University of North Carolina Department of Psychiatry is a 3-year, longitudinal experience open to residents starting in postgraduate year 2. To our knowledge, this is the first track of its kind within a psychiatry residency training program.